Abstract

Aim/Background

Fifteen to thirty percent of lung cancer patients will have supraclavicular and cervical lymphadenopathy (SCLN). Ultrasound (US) guided Fine Needle Aspiration (FNA) Cytology is regarded as an effective diagnostic tool in small size lymph nodes and impalpable Positron Emission Tomography (PET) detected nodes. We evaluated our diagnostic service performance, in relation to the adequacy of samples for epidermal growth factor receptor (EGFR) mutation. However, to our knowledge, there has been no confirmation that US guided FNA of neck and SCN samples are adequate for EGFR mutation detection. Therefore, we evaluated our diagnostic service performance of US guided NA of SCN with regard to adequacy of samples for detection of EGFR mutations.

Methods

Retrospective data analysis from electronic records, searching for all suspected lung cancer referrals that underwent US of the neck ± FNA, over a continuous period of four years.

Results

Of 306 cases with suspected lung cancer referred to our department for US- FNA of SCLN, 228 patients underwent the procedure. Of the remaining 78 patients, Lymph nodes (LNs) were not detected in 52, and 26 patients' LNs appeared benign. Cytological diagnosis was established in 171 patients (75%) for treatment decisions without further investigations. The remaining 57 patients had further investigations; 45 re-confirmed the US guided FNA diagnosis. The average LN size was 12.9mm and positive cytology was obtained in LNs ranging from 3 to 45mm. Of 57 adenocarcinoma cases, 34 were tested for EGFR confirming 4 positive, 25 negative and 5 insufficient samples. No complications were recorded.

US Guided FNA vs

Sensitivity % (CI)

Specificity % (CI)

PPV % (CI)

NPV % (CI)

PLR

NLR

All Further Tests

76.9 (63.2 to 87.5)

100 (47.9 to 100)

100 (91.1 to 100)

29.4 (10.4 to 55.9)

NA

0.23 (0.2 to 0.4)

Core LN Biopsy

81.2 (59.7 to 94.7)

100 (16.6 to 100)

100 (81.3 to 100)

20 (3.3 to 71.2)

NA

0.18 (0.1 to 0.5)

Bronchial Washings

69.2 (38.6 to 90.7)

100 (30.5 to 100)

100 (66.2 to 100)

42.9 (10.4 to 81.3)

NA

0.3 (0.1 to 0.7)

Lung Biopsy

57.1 (18.8 to 89.6)

100 (16.6 to 100)

100 (40.2 to 100)

25 (4.1 to 79.7)

NA

0.4 (0.2 to 1.0)

Conclusions

US guided FNA of SCLN remains an important diagnostic tool in lung cancer. Adequate tissue can be obtained for reliable diagnosis from LNs and for EGFR mutational analysis, without the need for more invasive and expensive investigations in more than 80% of cases.